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The Old Friary

Don’t Bragg

It was a great surprise to receive a letter some months ago from Lord Bragg (he of unimpeachable Melvynous South Banksy fame) asking if I might consider taking over from him as President of the charity MIND. Only a few years ago MIND had paid me the great compliment of appointing me their 2007 mental health “Champion” so I was fully aware of the organisation and the fine work they did.

MIND, as you may or may not know is, in its (I should now say “our”) own words: “the leading mental health charity in England and Wales.” This is not to take away from SANE and the indefatigable Marjorie Wallace, or the work done by dozens, indeed hundreds, of smaller more locally based mental health charities up and down the country. I cannot bear it when charities, of all institutions, regard each other as rivals or even enemies. The superb Time to Change for example, is a result of cooperation across the sector. It also gave me great pleasure when this coalition government, for all that it is not my idea of the political dream team of the century (but which government ever was?) made good strides towards placing the issue of stigma front and centre with their initiative Shift.

The Secret Life…

So, why me? Well, as some of you may know, five years ago I made two one hour films for the BBC called “The Secret Life of the Manic Depressive,” in which I told the story of my own history of cyclothymia, Bipolar Disorder, manic depression – call it what you will. Some of those I met in the course of making the films told harrowing and extraordinary stories of their struggles living with this common, and commonly misunderstood, mood disorder.

Those films certainly did seem to have quite an effect. I can quite truthfully say nothing I had ever done before or have done since, has resulted in such a mailbag. It sometimes seemed that as many doctors as lay people were writing to thank me or to take issue with or expand upon some point made in the programmes. Ross Wilson, the producer/director and I were very gratified when we were awarded an International Emmy. I had the honour too of being made a Fellow of Cardiff University: Professor Nick Craddock there had undertaken what was then I think the world’s largest genetic study of bipolar disorder (warning, v scholarly!) and I was proud to accept the Fellowship as a way of showing my admiration for his team’s work and his university’s unstinting support of it. The Royal College of Psychiatrists got me all flustered and proud too by appointing me an honorary fellow. The College’s campaign to encourage more talented medical students to choose psychiatry as a specialist study as they advance through their courses is immensely important. It seems that today’s medical student regards mental health as a less “sexy” branch of medicine in which to specialise than cardiology, say or oncology. I can only hope that this soon changes, for the advances being made in neurology, genetics, pharmacology and endocrinology show that, in fact, studying the physiology of the brain and the nature of the mind is just about the most exciting field there is in all medicine.

Polar Opposites

As with all mental illnesses, the problems posed for the person afflicted with bipolar disorder are often matched by the suffering, embarrassment, distress and indignity endured by those who live with and love them. On top of this, worst and most pernicious off all, is the stigma that goes with mental illness. It is bad enough to be afflicted by a condition that destroys the ability to find savour, pleasure, joy, energy, purpose or hope in life without being stared at, mocked or dismissed as some kind of freak, weirdo, social misfit or fraudulent hypochondriac.

The awful black feelings, it should be pointed out at once, are only half of bipolar disorder, a condition which deals its blows by swinging between a depressed mood of hopelessness and its polar opposite (hence the name) – an elevated mood of euphoric grandiosity, energy, self-belief and sometimes an embarrassing loss of social or sexual inhibition. It is is easy to think that these upswings are a kind of compensatory bonus that allow manic depressives to be more creative and artistic than other people. While it may be true that certain celebrated writers, painters, composers, statesmen, warriors and inventors have appeared (inasmuch as such retrospective diagnosis can safely be believed) to have been manic depressives, anyone who lives with a seriously bipolar person can tell you that the manic elevated mood is in fact harder to cope with than the black depressed one and that “creative” is not a word one would often use of it. This is not even to mention the “mixed” or “transitional” states that often combine the worst aspects of both extremes.

Let no one be under any illusions. At its most serious, bipolar disorder can be a very very serious condition. Its morbidity rate is high, often because it can typically trace a descent from social norms and supportive structures into homelessness, friendlessness and all the disastrous effects on physical health that poverty, addiction, social rejection and loneliness bring in their train.

Those who think manic depression is a “celebrity disorder” made up by tabloid cuties to excuse their excesses, addictions and descents into bad behaviour, should look at mental health’s most serious victims: the marginalised, the poor, the ethnically isolated, the lonely. They have no voice, save the jeers of stone and insult throwing louts, it is they who form the silent majority of sufferers.

Self Medication

It can be no surprise that so many with bipolar disorder, a condition over which they have no control, reach for something that can predictably lift or lower their mood at their bidding in their own time and under their own terms. Drugs and alcohol appear to offer at least that kind of relief. This is known in the trade as “self-medication” or amongst those without sympathy, imagination, sense or decency as “a feeble excuse for weakness” or “self-indulgent nonsense”. But just imagine how tempting it is to reach for a bottle or narcotic powder: the intensity and misery can be numbed and life can seem more bearable. At a cost, naturally: a financial cost, a social cost, a physiological cost, a cost that can lead to ruin. As with all addictions progressively more of the stuff is needed to produce the same effect until inevitably the substance abuse becomes the problem, masking the mood disorder beneath.

Which is not to say that all alcoholics or drug addicts are bipolar or that all with bipolar disorder succumb to substance abuse. The uncomfortable, as well as the miraculous, fact about the human mind is how it varies from individual to individual. The process of treatment can therefore be long and complicated. Finding the right balance of drugs, whether lithium salts, anti-psychotics, SSRIs or other kinds of treatment can be a very hit or miss heuristic process requiring great patience and classy, caring doctoring. Some patients would rather reject the chemical path and look for ways of using diet, exercise and talk-therapy. For some the condition is so bad that ECT is indicated. One of my best friends regularly goes to a clinic for doses of electroconvulsive therapy, a treatment looked on by many as a kind of horrific torture that isn’t even understood by those who administer it. This friend of mine is just about one of the most intelligent people I have ever met and she says, “I know. It ought to be wrong. But it works. It makes me feel better. I sometimes forget my own name, but it makes me happier. It’s the only thing that works.” For her. Lord knows, I’m not a doctor, and I don’t understand the brain or the mind anything like enough to presume to judge or know better than any other semi-informed individual, but if it works for her…. well then, it works for her. Which is not to say that it will work for you, for me or for others.

I’m lucky, but…

If I am to use my “name” such as it is, to bang the drum for the cause of increasing society’s understanding and awareness of mental health and its issues, it is important for me to make sure that it is understood that I do know how lucky I am. Lucky to have friends, money and a light enough version of manic depression to make it less likely for me to suffer from the worst excesses of the condition.

I won’t lie, however, and when asked as I occasionally am, I cannot pretend. There truly are days when what is known as “suicidal ideation” has consumed me and it has taken all the effort I have to keep me from choosing the exit door from which there is no return. When I have mentioned this in print or interview it has, quite naturally, distressed those close to me or those, knowing me or not, who care about my well-being. I realise this and also understand why people think it would be better for me to shut up about all that rubbish rather than appear to welter in the fancy exotic luxury of having an “interesting” condition. It is important for me, as much as for anybody else, to understand that while my particular mood disorder might be what Americans sometimes call “Bipolar Lite”, it is still enough of a potential threat to my very existence for me to be wary about dismissing my version of this chronic condition out of respect for those who have it much worse.

Chronicling the chronic…

For some reason the word “chronic” often has to be explained. It does not mean severe, though many chronic conditions can be exceptionally serious and indeed life-threatening. No, “chronic” means persistent over time, enduring, constant. Diabetes is a chronic condition, but measles is not. With measles, you contract it and then it is gone. It can sometimes be fatal, but is never chronic. Manic depression, in other words, is something you have to learn to live with. There are therapies which may help some people to function and function for the most part happily and well. Sometimes a talking therapy, sometimes pharmaceutical intervention helps. Many in the psychiatric profession would suggest that neither talking nor drug therapies are as good on their own as they can be when used together. Some talk therapies might involve long term analysis, others utilise the quicker and more practical fix offered by methodologies like Cognitive Behavourial Therapy, which does not presume to understand root causes, but instead can offer tools and strategies for coping.

Other forms of mental ill-health…

I have gone on at some length about bipolar disorder because it is the condition I have most attempted to grapple with and comprehend. But there are many kinds of mental health problem which eat away at the happiness and prosperity of our country. Issues of self-image, like the kinds of body dysmorphia that can lead to life-threatening eating disorders for example; then there is the rising incidence amongst the young of self-mutilation and other forms of self-harm, there are unipolar depression, schizophrenia, learning disabilities, ADHD, Tourette’s, obsessive compulsive disorders of various kinds; there is autism and Asperger’s and there are all manner of phobias, syndromes and conditions that society often finds it hard to separate from the personality and even the moral worth of the sufferer. It is not for me here to say that all behaviours, moods, reactions and attitudes are attributes of brain and nothing to do with character, personality and what we are used to thinking of as “goodness” and “wickedness” – but I think any reasonable person can accept that the brain as an organ and the neural networks within it are quite as likely to suffer dysfunction as the back, the heart or the kidneys.

Of course the less merciful will say, “ how convenient that makes it for every criminal to be able to plead this syndrome or that condition as an excuse for crime and anti-social behaviour.” I am not pretending that this is not a real problem facing courts, but it is one that has been thought about hard for many many years and forensic criteria are constantly being established, declassified or refined. The best known collection of these definitions is the Diagnostic and Statistical Manual of Mental Disorders, the DSM, currently in its revised 4th edition, though soon to be reissued as the all new DSM 5. An unavoidably controversial publication, it seeks to distil current understanding of what is and what is not a “true” condition that passes empirical, rational testing in ways that everyone from a jury to an insurance company can agree upon or at least come close to understanding. In the forthcoming 5th edition, or so it is rumoured, the word “spectrum” will no longer be used to describe various sorts of autism, but rather each kind will be given its own individual ascription. In the its early editions, homosexuality was characterised as a disease, so it can be seen that the DSM is very much a work in progress and a reflection as much of public mores as eternal medical verities.

Why me…?

If you are in the public eye there are often many calls upon your time and name. It is, quite literally, impossible to accede to every demand that comes one’s way, just in terms of patronage of societies or positions on their boards and committees, let alone agreeing to the numerous requests for public appearances, tweets, retweets and bloggings.

So I have to make choices. Many years ago I decided to devote time to the Terrence Higgins Trust, Europe’s largest HIV/AIDS charity and busier now than it has ever been. I had reason enough, with friends dying in the 1980s, to align myself there. I have had experiences on my travels with wildlife conservation that have made it natural to accept a position as Vice President of Fauna and Flora International. There are other causes close to my heart because of their connections to the part of the country I grew up in or the passions that I pursue. To that end I’ve already written about the pleasure I derive from being a trustee of the Royal Academy and a director of Norwich City Football Club and I felt no less pride when asked to take over from Lord Attenborough last year as Chairman of the Criterion Theatre, Piccadilly.

Just when I thought I had committed myself enough in all directions, along came the letter from Melvyn. He gave fifteen years of his life in service to MIND and they could have had no more passionate, purposeful or persuasive advocate. I was happy to accept therefore, giving only the warning that my life takes me all over the place and that I cannot ever pledge to be present at every board meeting or gathering that so busy and far-reaching an organisation as MIND is likely to want me at. They seem, thank goodness to understand that.

Not a poster child….

I hope too, that it is understood by others, that while I appreciate and recognise entirely why so many people email and tweet me about their own mental health issues it is a little difficult sometimes being considered the public face of an affliction like bipolar disorder. I felt proud to be able to make those programmes about it, and I will continue when and where I can to try and address as much as anything the stigma and the lack of diagnosis that can make a hard condition harder, but it is not easy receiving so much mail, so much twitter traffic and having so many souls asking for advice, wondering how I am, seeking guidance on coping mechanisms for themselves or even requesting long distance diagnosis for themselves or others.

I sincerely do understand why people might want to, but in the end it’s a disorder that at its worst is very serious and which, when I am lucky enough to be stable, I’d rather not constantly be reminded about, quizzed about, nudged about. I know it’s foolish and ungracious to complain and I do understand why I am so commonly asked questions on the subject, even though it is a little like having lemon-juice dropped on a fresh cut.

Mental health is one of the last great taboos. I will do my best with MIND as they, along with others in the sector, fight hard against the injustice, ignorance, stigma and indifference which still threaten society’s own good mental health. Where I can use the example of my own experiences I naturally will, but not at the risk of driving myself to the brink…

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For those with a problem …

I can only end with this plea. If you think you have a mental health problem, see a doctor. Don’t write to me, I really am not qualified! There are plenty of sites out there filled with advice and links to sites where you might find people with similar issues, MIND’s own site is as good a place to start as I know.

If you do see a doctor and feel they are fobbing you off, do not allow it or stand for it. Insist upon your right to see another physician. Explain your symptoms as clearly and as honestly as you can – in terms of yourself and how you feel, not in terms of how you think others see you or how the world may or may not view you. A doctor who does not listen, counsel and suggest an approach to treatment is not worthy of their licence. But I’m afraid to have to tell you that such is current state of medical science, a lot of the work will have to be done by you. There are no magic bullets, either in drug or any other form, and it is a long journey that may involve mood diaries, changes in diet, exercise and sleep patterns and all kinds of solutions that are harder than a pill, a powder or a pint.

Best of luck. It may not seem it, but there are millions out there like you and there are thousands who want to help you feel better about life and yourself. MIND is one such and as its new president, I welcome you.

No problem…?

If you are lucky enough to be in sound mental health, it is almost certain that you know someone who is not or that you are a concerned or caring person. No one else would have bothered to read this far. MIND could use your help in all kinds of ways. Don’t be shy…